An abnormal chest radiograph in a patient with recurring high altitude pulmonary edema.

A 40-year-old man with the acquired immunodeficiency syndrome (AIDS) was admitted for evaluation of dyspnea, nonproductive cough, and fever of five days' duration. Six months earlier, he had been treated at another hospital for Pneumocystis carinii pneumonia and was subsequently begun on therapy with 3T-azido-3'-deoxythymidine (AZT). His past medical history was remarkable for the presence of a rightsided aortic arch, which had been noted on chest radiographs for many years. The patient reported that this abnormality was also present in his father. His prior pulmonary history was remarkable for an episode of dyspnea and cyanosis during a trip to Quito, Equador, at age 17, which was diagnosed as highaltitude pulmonary edema. At age 28, a similar episode occurred with the development of dyspnea and angina during a trip to Aspen, Colorado. With the exception of these episodes, he was without respiratory com-